Treatment: ART among People Diagnosed with HIV Infection

Export Indicator

Percentage of people diagnosed with HIV infection who need antiretroviral therapy and who receive it
What it measures

The efficiency of providing antiretroviral combination therapy to all people diagnosed with HIV infection who are eligible for treatment.

Rationale

Antiretroviral therapy (ART) has been shown to reduce mortality among people living with HIV and efforts are being made globally to scale-up ART. These efforts require prompt diagnosis of HIV infection, equitable policies and guidelines on ART eligibility and efficient delivery of therapy to those who need it.

Numerator

Number of people diagnosed with HIV infection who are currently receiving antiretroviral therapy in accordance with the nationally-approved treatment protocol (or WHO/UNAIDS standards) at the end of the reporting period.

Denominator

Number of people diagnosed with HIV infection who are eligible for ART. Eligibility should be defined according to national guidelines, where available. Where national guidelines are not available, international guidelines should be used. Currently, these guidelines recommend treatment for any person with HIV with a CD4 count less than 350 cells/mm3 or any person with HIV with an AIDS-defining illness, such as tuberculosis, regardless of CD4 count.

Calculation

Numerator / Denominator

Method of measurement

Programme monitoring. For the numerator: facility-based antiretroviral therapy registers or drug supply management systems. For the denominator: clinical and/or laboratory records/databases.

Measurement frequency

Continuously

Disaggregation

Age group: (greater than) 15 years,

Gender: Male, Female

Target: Sex workers, Injecting drug users, Men who have sex with men, Prisoners, Other

Explanation of the numerator

Explanation of Numerator
The numerator can be generated by counting the number of people receiving antiretroviral therapy at the end of the reporting period. The numerator should equal the number of people who ever started antiretroviral treatment minus those patients who are not currently on treatment at the end of the reporting period. Patients not currently on treatment at the end of the reporting period include those who died, stopped treatment or are lost to follow-up.

Antiretroviral therapy taken only for the purpose of prevention of mother-to-child transmission or post-exposure prophylaxis is not included in this indicator. HIV-infected pregnant women who are eligible for antiretroviral therapy and on antiretroviral therapy for their own treatment are included in this indicator.

Patients receiving antiretroviral therapy in the private sector and public sector should be included in the numerator.

Explanation of the denominator

Explanation of Denominator
The denominator can be generated by counting the number of people who meet eligibility criteria for antiretroviral therapy at the end of the reporting period. The denominator should exclude people known to have died since becoming eligible for treatment.

Strengths and weaknesses

This indicator provides information about the efficiency of provision of antiretroviral treatment to those who have been diagnosed with HIV and who are considered to need treatment. It does not give information about those people living with HIV who might be in need of treatment but who have not yet been diagnosed. It is therefore important that this indicator be analysed alongside an indicator of the rate of late diagnosis.

In order to interpret data from this indicator, a clear understanding is needed of the national policy on eligibility for antiretroviral therapy.

This indicator is more appropriate for most of the countries in the European region than one using modelled estimates of the number of people with advanced HIV infection as these models are not applicable to high income countries.

Further information

Further Information
ECDC (2010) Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and central Asia: 2010 Progress Report Section 3.1 Treatment and Care pp. 137-144. http://ecdc.europa.eu/en/publications/Publications/1009_SPR_Dublin_decla....

Special Note
As for all indicators related to monitoring the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and central Asia, where a country does not have data for the indicator specified but has data for a similar indicator, the country is welcome to submit such data when reporting. When submitting alternate data, please provide as much detail as possible as to what information is being supplied.